Botulinum Toxin in Paediatric Neuro-Rehabilitation

Abstract

Background: Botulinum neurotoxin (BoNT) is a frequently used therapeutic agent in the field of movement disorders, especially in spastic cerebral palsy (CP) and focal dystonias. While there are many studies concerning the therapy of CP with BoNT, little is known about the effectiveness and efficacy of this agent in children in rehabilitation, for example, after traumatic brain injury or other acquired brain injuries. Nevertheless, BoNT is often used for tonus modulation, also in combination with other pharmacological interventions, for the facilitation of therapeutic, orthopedic, and caring procedures, as well as the reduction of drooling. Methods: The application of BoNT in rehabilitation was evaluated with the help of questionnaires for the upper and lower extremities and the head–neck area. The evaluation was performed after 4 and 8 weeks, respectively, by internal physical or occupational therapists. Overall, 45 questionnaires of patients aged 1.3 to 18.5 years were analyzed. Results: In 61.5% (lower extremities) and 62% (upper extremities) of cases, the local efficacy of BoNT at the individual muscle was evaluated as being “good.” Side effects were only observed in one case. Fortunately, in 85.7%, the therapy with BoNT facilitated therapeutic procedures. This leads to the recommendation of further application of BoNT in similar situations in 81% of the cases for the lower extremities. Conclusion: Even if the local effect at the individual muscle seems not to be always in an optimal range, the overall therapeutic effect facilitates physical and occupational therapies and therefore is an important component in rehabilitation.